Faculty Bibliography

BACKGROUND:Image-guided joint aspirations used to assist the diagnosis of periprosthetic joint infection (PJI) may commonly result in a dry tap-or insufficient fluid for culture and cell count analysis. Dry tap aspirations are painful and invasive for patients and often utilize a subsequent saline lavage to obtain a microbiology sample. Currently, there is a paucity of the literature addressing predictors that could suggest whether a dry tap will occur. The purpose of this study was to examine the effects of various factors on "dry tap" occurrence in patients with suspected PJI following total hip arthroplasty (THA). METHODS:A retrospective review was performed among THA patients suspected for PJI who received image-guided joint aspiration procedures at our institution from May 2016 to February 2020. The procedural factors included the imaging modality used for aspiration, anatomic approach, needle gauge size used, and the presence of a trainee. The patient-specific factors included number of prior ipsilateral hip surgeries, femoral head size, ESR/CRP values, and BMI. RESULTS:In total, 336 patients met our inclusion criteria. One hundred and twenty hip aspirations resulted in a dry tap (35.7%) where the patients underwent a saline lavage. Among the procedural and patient-specific factors, none of the factors were found to be statistically different between the two cohorts nor conferred any greater odds of a dry tap occurring. CONCLUSION/CONCLUSIONS:No associations with dry tap occurrence were found among the procedural and patient-specific factors studied. Further research is needed to identify additional factors that may be more predictive of dry taps.

OBJECTIVE:Texture features are proposed for classification and prognostication, with lacking information about variability. We assessed 3 T liver MRI feature variability. METHODS:Five volunteers underwent standard 3 T MRI, and repeated with identical and altered parameters. Two readers placed regions of interest using 3DSlicer. Repeatability (between standard and repeat scan), robustness (between standard and parameter changed scan), and reproducibility (two reader variation) were computed using coefficient of variation (CV). RESULTS:67%, 49%, and 61% of features had good-to-excellent (CV ≤ 10%) repeatability on ADC, T1, and T2, respectively, least frequently for first order (19-35%). 22%, 19%, and 21% of features had good-to-excellent robustness on ADC, T1, and T2, respectively. 52%, 35%, and 25% of feature measurements had good-to-excellent inter-reader reproducibility on ADC, T1, and T2, respectively, with highest good-to-excellent reproducibility for first order features on ADC/T1. CONCLUSION/CONCLUSIONS:We demonstrated large variations in texture features on 3 T liver MRI. Further study should evaluate methods to reduce variability.

CONTEXT/UNASSIGNED:Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. AIMS/UNASSIGNED:We sought to describe strain findings in both the groups on initial presentation and follow-up. SETTINGS AND DESIGN/UNASSIGNED:A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. SUBJECTS AND METHODS/UNASSIGNED:TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. RESULTS/UNASSIGNED:= 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. CONCLUSIONS/UNASSIGNED:Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.

Though consistently shown to detect mammographically occult cancers, breast ultrasound has been noted to have high false-positive rates. In this work, we present an AI system that achieves radiologist-level accuracy in identifying breast cancer in ultrasound images. Developed on 288,767 exams, consisting of 5,442,907 B-mode and Color Doppler images, the AI achieves an area under the receiver operating characteristic curve (AUROC) of 0.976 on a test set consisting of 44,755 exams. In a retrospective reader study, the AI achieves a higher AUROC than the average of ten board-certified breast radiologists (AUROC: 0.962 AI, 0.924 ± 0.02 radiologists). With the help of the AI, radiologists decrease their false positive rates by 37.3% and reduce requested biopsies by 27.8%, while maintaining the same level of sensitivity. This highlights the potential of AI in improving the accuracy, consistency, and efficiency of breast ultrasound diagnosis.

RATIONALE AND OBJECTIVES/OBJECTIVE:The COVID-19 pandemic stresses the tenuous balance between domestic obligations and academic output for women across professions. Our investigation aims to evaluate the impact of the pandemic on the home duties and workplace productivity of academic radiologists with respect to gender. MATERIALS AND METHODS/METHODS:A 49-question survey was distributed to 926 members of Association of University Radiologists in October 2020. Several categories were addressed: demographics; workplace changes; stress levels and personal experiences with illness; time spent on domestic obligations; and perception of productivity during COVID-19. Statistical analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). RESULTS:A total of 96 responses across 30 states, 53.1% male and 46.9% female were received. Women report spending more time on unpaid domestic duties than men prior to COVID-19, with men spending a median of 5-10 h/wk and women spending a median of 10-15 h/wk (p = 0.043). With pandemic onset, both genders reported that women did more of the homecare, when not split equally. Women with young children reported a significant decrease in work-from-home productivity compared to men with young children (p = 0.007). Men reported they had more time to be productive compared to women (p = 0.012). CONCLUSION/CONCLUSIONS:The COVID-19 pandemic threatens to disrupt the advancement of women in radiology leadership roles by creating disparate effects on productivity due to increased workloads at home for women. This could potentially lead to decreases in promotions and research productivity in years to come that far outlast the acute phases of the pandemic.

OBJECTIVE:To evaluate the influence of coronary artery dominance on observed coronary artery calcification burden in outpatients presenting for coronary computed tomography angiography (CCTA). METHODS:A 12-month retrospective review was performed of all CCTAs at a single institution. Coronary arterial dominance, Agatston score and presence or absence of cardiovascular risk factors including hypertension (HTN), hyperlipidemia (HLD), diabetes and smoking were recorded. Dominance groups were compared in terms of calcium score adjusted for covariates using analysis of covariance based on ranks. Only covariates observed to be significant independent predictors of the relevant outcome were included in each analysis. All statistical tests were conducted at the two-sided 5% significance level. RESULTS:1223 individuals, 618 women and 605 men were included, mean age 60 years (24-93 years). Right coronary dominance was observed in 91.7% (n = 1109), left dominance in 8% (n = 98), and codominance in 1.3% (n = 16). The distribution of patients among Agatston score severity categories significantly differed between codominant and left (p = 0.008), and codominant and right (p = 0.022) groups, with higher prevalence of either zero or severe CAC in the codominant patients. There was no significant difference in Agatston score between dominance groups. In the subset of individuals with coronary artery calcification, Agatston score was significantly higher in codominant versus left dominant patients (mean Agatston score 595 ± 520 vs. mean 289 ± 607, respectively; p = 0.049), with a trend towards higher scores in comparison to the right-dominant group (p = 0.093). Significance was not maintained upon adjustment for covariates. CONCLUSIONS:While the distribution of Agatston score severity categories differed in codominant versus right- or left-dominant patients, there was no significant difference in Agatston score based on coronary dominance pattern in our cohort. Reporting and inclusion of codominant subsets in larger investigations may elucidate whether codominant anatomy is associated with differing risk.

The aim of this study was to determine the feasibility of diffusion basis spectrum imaging in multiple sclerosis at 7 T and to investigate the pathological substrates of tissue damage in lesions and normal-appearing white matter. To this end, 43 patients with multiple sclerosis (24 relapsing-remitting, 19 progressive), and 21 healthy control subjects were enrolled. White matter lesions were classified in T1-isointense, T1-hypointense and black holes. Mean values of diffusion basis spectrum imaging metrics (fibres, restricted and non-restricted fractions, axial and radial diffusivities and fractional anisotropy) were measured from whole brain white matter lesions and from both lesions and normal appearing white matter of the corpus callosum. Significant differences were found between T1-isointense and black holes (P ranging from 0.005 to <0.001) and between lesions' centre and rim (P < 0.001) for all the metrics. When comparing the three subject groups in terms of metrics derived from corpus callosum normal appearing white matter and T2-hyperintense lesions, a significant difference was found between healthy controls and relapsing-remitting patients for all metrics except restricted fraction and fractional anisotropy; between healthy controls and progressive patients for all metrics except restricted fraction and between relapsing-remitting and progressive multiple sclerosis patients for all metrics except fibres and restricted fractions (P ranging from 0.05 to <0.001 for all). Significant associations were found between corpus callosum normal-appearing white matter fibres fraction/non-restricted fraction and the Symbol Digit Modality Test (respectively, r = 0.35, P = 0.043; r = -0.35, P = 0.046), and between black holes radial diffusivity and Expanded Disability Status Score (r = 0.59, P = 0.002). We showed the feasibility of diffusion basis spectrum imaging metrics at 7 T, confirmed the role of the derived metrics in the characterization of lesions and normal appearing white matter tissue in different stages of the disease and demonstrated their clinical relevance. Thus, suggesting that diffusion basis spectrum imaging is a promising tool to investigate multiple sclerosis pathophysiology, monitor disease progression and treatment response.

BACKGROUND:Emerging data suggest screening mammography may be effective in detecting breast cancer early in high-risk men. We evaluated current screening recommendations as a risk management strategy in men at elevated risk for breast cancer. PATIENTS AND METHODS/METHODS:This institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study reviewed consecutive men who underwent genetic counseling and multigene panel testing (MGPT) for breast cancer risk assessment at our institution between 2012 and 2018. Patient risk factors, test indications, and MGPT outcomes were recorded, then correlated with screening recommendations by either clinical breast examination or screening mammography. Recommendation consistency among practitioners was evaluated. Patient adherence to screening mammography (defined as undergoing screening mammography as recommended) was assessed. Statistical analysis was performed at the 2-sided 5% significance level. RESULTS:A total of 414 asymptomatic men underwent both genetic counseling and MGPT (mean age, 47 years; range, 18-91 years) for breast cancer risk assessment. Of this group, 18 (4.3%) of 414 had a personal history of breast cancer, and 159 (38.4%) of 414 had a family history of breast cancer before MGPT. Among 112 men with positive MGPT results, BRCA1/2 mutations were the most common (56.3%, 63/112). Most BRCA mutation carriers (80.9%, 51/63) were recommended clinical breast examination only. Only 5.9% (2/34) BRCA2 and 10.3% (3/29) BRCA1 carriers were recommended screening mammograms (7.9%, 5/63 of all BRCA carriers). Among men with a personal history of breast cancer, only 9 (50%) of 18 were recommended screening mammograms. Overall adherence to screening mammogram in men was 71.4% (10/14), which ultimately yielded two cancers. Breast cancer screening recommendations varied widely among practitioners, with some recommending clinical breast examination only, and others also recommending mammography. CONCLUSION/CONCLUSIONS:Men who are found to be at an elevated risk for breast cancer after undergoing genetic counseling and testing currently receive relatively inconsistent screening recommendations.

Background: Despite studies suggesting that blacks may be at greater risk of developing AD, there have been few studies investigating health disparities, and blacks have been underrepresented in many prominent AD biomarker studies and clinical trials. The current ATN biomarker classification system may not fully account for health disparities and can't explain the increased prevalence among blacks for both AD and AD vascular risks of diabetes and hypertension when compared to whites. Research on cognitive aging has traditionally focused on how decline in various cortical and hippocampal (Hip) regions influences cognition. However, tau pathology emerges decades before amyloid pathology, appearing first in the brainstem (BS); particularly in the locus coeruleus (LC), the source of brain's norepinephrine (NE). Our decade-long studies in humans using a norepinephrine transporter (NET)-selective radiotracer ([11C]MRB) have demonstrated a special vulnerability of LC to aging and stress.
Method(s): Co-registration of PET (dynamic [11C]MRB), MRI and the FreeSurfer (FS) atlas images of each individual was used to generate regional time-activity curves using Firevoxel. Binding potential (BPND) values were determined using MRTM2 with occipital as the reference region. Annual percent change (APC) of BPND was calculated based on linear regression (APC = 100 x (em-1), m: slope) and effects of age, gender and ethnicity on tracer binding were evaluated.
Result(s): For all HC (N=31), with both genders and all races included, age-sensitive decline of NET availability was observed; e.g., 0.3-0.5%/yr for Hip, BS and olfactory. However, our data reveals that the decline rate of NET is much faster among blacks starting in the mid-30s, particularly in black males; e.g., 2-3%/yr vs. 0.14-0.23%/yr in thalamus and brainstem for black males vs. white males (p < 0.00001).
Conclusion(s): In addition to our previously determined age effect on MRB-NET binding, this report further reveals the role of ethnicity effects on NET availability. Our study showed that a faster decline of LC-NE function occurs in blacks, possibly caused by cumulative stress to socioeconomic disadvantage and racial discrimination and may be responsible for the different disease expression among blacks. Thus, NET availability imaging represents a novel biomarker approach to racial-dependent strategies for diagnosis and assessment of therapeutic interventions

The pathological cascade of tissue damage in mild traumatic brain injury is set forth by a perturbation in ionic homeostasis. However, whether this class of injury can be detected in vivo and serve as a surrogate marker of clinical outcome is unknown. We employ sodium MRI to test the hypotheses that regional and global total sodium concentrations: (i) are higher in patients than in controls and (ii) correlate with clinical presentation and neuropsychological function. Given the novelty of sodium imaging in traumatic brain injury, effect sizes from (i), and correlation types and strength from (ii), were compared to those obtained using standard diffusion imaging metrics. Twenty-seven patients (20 female, age 35.9 ± 12.2 years) within 2 months after injury and 19 controls were scanned with proton and sodium MRI at 3 Tesla. Total sodium concentration, fractional anisotropy and apparent diffusion coefficient were obtained with voxel averaging across 12 grey and white matter regions. Linear regression was used to obtain global grey and white matter total sodium concentrations. Patient outcome was assessed with global functioning, symptom profiles and neuropsychological function assessments. In the regional analysis, there were no statistically significant differences between patients and controls in apparent diffusion coefficient, while differences in sodium concentration and fractional anisotropy were found only in single regions. However, for each of the 12 regions, sodium concentration effect sizes were uni-directional, due to lower mean sodium concentration in patients compared to controls. Consequently, linear regression analysis found statistically significant lower global grey and white matter sodium concentrations in patients compared to controls. The strongest correlation with outcome was between global grey matter sodium concentration and the composite z-score from the neuropsychological testing. In conclusion, both sodium concentration and diffusion showed poor utility in differentiating patients from controls, and weak correlations with clinical presentation, when using a region-based approach. In contrast, sodium linear regression, capitalizing on partial volume correction and high sensitivity to global changes, revealed high effect sizes and associations with patient outcome. This suggests that well-recognized sodium imbalances in traumatic brain injury are (i) detectable non-invasively; (ii) non-focal; (iii) occur even when the antecedent injury is clinically mild. Finally, in contrast to our principle hypothesis, patients' sodium concentrations were lower than controls, indicating that the biological effect of traumatic brain injury on the sodium homeostasis may differ from that in other neurological disorders. Note: This figure has been annotated.